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RE: [IP] Bruising at cannula insertion site



Hi, Brad --

thank you for the detailed reply, which makes answering so much
easier. Things are becoming clear:

 > [...]  Paradigm Quick-Set.

You are correct, this is a 90deg Teflon-cannula set. With the 6mm
cannula, you get a 9mm introducer needle. Add another 3mm of slop
(the skin and fat layers compress a little during insertion and
pull apart afterwards), and you'll find that ideally, you'll want
12mm of skin+fat where you insert. (You can fake some of that by
slightly pinching up a sort-of-hill under the set, to temporarily
increase the distance from skin to muscle layer.)

 > My first set was in my left side, about 3" below
 > my rib cage and about 2" above the waist line of
 > my jeans.

Even with the sensitivity of your abdominal area, you may want to
try that first. The sides are usually less padded than the front,
and if there is no or next-to-no fat layer in a spot, the only set
that works for me is an angled set ("Silhouette" a/k/a Sil, 13mm
cannula for me).

 > When I removed the old one I had an indention on
 > my skin of the cannula which was bent at a
 > 90degree angle.

That is why, for straight-in sets, I prefer the automatic
insertion method -- and once you don't use it in spots where there
isn't enough fat, you will no longer consider it a method of
torture. Angled sets, on the other hand, I prefer to insert
manually.

 > I hate the spring loaded device. Hurts like crazy.

It's not the device. It's the needle hitting the muscle underneath
the fat layer.

 > Medtronic knew my height and weight and recommended
 > this Quickset. But my trainer was surprised they
 > didn't send me the Silhouette (the angled one), as
 > I'm tall and lean.

I'll say. Normally, the initial set is recommended by the doctor
prescribing the pump, I believe. I was my doc's first pumper back
when and therefore got to meet the Medtronic rep, an RN, who
recommended a set to start with.

 > Though I'd think rolling onto it would force it in
 > all the way, not pop it out.

Generally, if the cannula is nicely ensconced in the sub-q fat, it
won't pop out. However, imagine that one fingertip of yours is
pushing down on the outermost edge of the inserted set (that would
be the edge of the ring connecting tubing to hub). Obviously, the
other edge, and the hub itself, will be lifted, sort of like a
see-saw. So, yes, it is possible to pop the cannula out. Less fat,
more popping out.

 > Personally I think this Quick-Serter is poorly
 > designed: it has two buttons on opposite sides
 > that both need to be pushed simultaneously.

But it fulfils the most important engineering requirement: It is
Good Enough. It works. And unless you have sticky tape from a
failed insertion gunking up the works, the deviation from 90deg is
too small to make a difference, not to mention that the introducer
needle will keep the cannula straight during the process.

 > Plus the Quickset fell out of the device twice
 > just lifting the Quick-Serter up to my side.

Did you push it in far enough? The non-sticky side of the tape of
the set is in contact with the white part of the Quickserter, if
done right -- at that point, a pair of plastic prongs engage the
set's blue handle and hold it in place. Just give the needle
protector cone a good shove to make sure the set is seated
properly before you remove the cone.

 > I always found it too tender/uncomfortable due
 > to the lack of a fat layer.

And we get to the meat of the matter. I am happy to share that
problem (used to be, I had enough fat layer that you could have
inserted the nozzle of a gas station pump without my noticing),
and my fix is to use angled sets.

I pull up a skin fold such that the long sides of the fold, the
ones pinched by my fingers, run across my body; the short sides
are sot-of in the head-to-toe direction. The I manually punch the
Sil into the short side, such that it is flat (parallel to the
plane of the abdomen). I let go of the fold, pat the set down,
pull the introducer needle out, stick the other half of the set
down, done. That works in location with no discernible fat at all,
like the thighs (but try to avoid sticking the set smack into a
visible vein :-) ).

 > I could feel the infusion set "jiggle" on my side
 > and had a sharp pain where I could feel the cannula
 > moving in my side, like a needle pushing deeper.

Ouch. After inserting the set, you shouldn't feel it, period. If
it hurts after a minute, something is most likely wrong.

 > I was planning on doing a zigzag, but alternating
 > sides each time... Then working my way up/down
 > from the last spot.

That'll work just fine. The whole point, as you know, is just to
give an area a bit of a rest between insulin soakings.

 > I can't really use the area directly around my
 > navel... Too hairy.

Shave the hairs off. If you think that a shaved stomach is
unmanly, why, you can use those god-awful wax strips that women
inflict on themselves and brag to your pals how pain doesn't
bother you at all. :-)

One final item: Call MM, tell them you have N unopened boxes of
Paradigm Quicksets (they may want the lot number) and a
Quickserter, neither of which you can use, and you want
Silhouettes (13mm cannula, if you are that lean). There is a
Sil-Serter, but even I refuse to use that thing. Not that it
hurts, but for little sub-q fat, manual insertion gives better
angle control; if you have to use the skin-fold method above, the
inserter gets in the way; and loading the inserter takes about as
much time as just punching the set in by hand.

Cheers,
Felix.
.
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